Medicare Advantage Plans in Rhode Island

Seniors enrolling in Medicare have the option of choosing Original Medicare or Medicare Advantage. Although both types of Medicare cover many of the same services, Medicare Advantage, also known as Medicare Part C, isn’t administered by the federal government. Instead, private insurance companies sell Medicare Advantage Plans within specific service areas, giving Rhode Island residents additional coverage options.

All Original Medicare enrollees have the same out-of-pocket costs, regardless of where they live. With Medicare Advantage, out-of-pocket costs vary based on plan type and provider. However, Original Medicare does not have a yearly annual maximum, but Medicare Advantage plans do. Another difference is that Original Medicare beneficiaries are allowed to go to any doctor or hospital that accepts Medicare, while a senior enrolled in Medicare Advantage often must go to doctors and hospitals within their plan’s network for non-emergency care. Original Medicare enrollees have the option of purchasing Medigap coverage to help with their out-of-pocket costs. Medicare Advantage enrollees don’t need to buy Medigap policies.

Medicare Advantage has proven to be a popular option for Rhode Island residents, as the state has 111,420 people enrolled in Medicare Part C as of 2021. This represents about 48% of Rhode Island’s total Medicare-eligible population. The overall Medicare Advantage enrollment rate in the United States is 42%.

This guide provides an overview of Medicare Advantage coverage in Rhode Island, along with details about some of the most popular plans available. It also includes tips on determining eligibility and finding a high-quality Medicare Advantage Plan.

The Top 8 Medicare Advantage Plans in Rhode Island

Several types of Medicare Advantage Plans are available in Rhode Island. The following table lists the 10 most popular plans, along with information on plan pricing and enrollment numbers. Because Medicare Advantage providers typically offer more than one plan, the enrollment numbers for each plan were combined to determine the total number of members for each provider in Rhode Island. The cost information is also presented as a range to account for price differences between plans. All cost and enrollment numbers were accurate as of April 2022, but any senior who needs the current data should visit Medicare.gov to learn more.

How Medicare Advantage Plans Work in Rhode Island

Medicare Advantage Plans differ from Original Medicare because they require members to use doctors and hospitals within a specific network. The rules regarding in-network and out-of-network coverage depend on the type of plan selected. In Rhode Island, Medicare Advantage providers offer four main types of plans. More information about each type is available below.

What Medicare Advantage Plans Cover in Rhode Island

Original Medicare doesn’t cover routine vision care, dental care or hearing aids, and coverage for other services may also be limited. What makes Medicare Advantage so attractive to its members is that providers are allowed to offer extra benefits that aren’t included in Original Medicare. Therefore, some plans cover hearing aids, dentures, eye exams and other services. With the exception of hospice care, Medicare Advantage covers the same medically necessary services as Original Medicare, including inpatient hospital care, preventive care, health screenings and diagnostic tests. Some Medicare Advantage plans also cover gym memberships or transportation to medical appointments.

*Select plans offer this coverage

** Most plans offer this coverage

Eligibility for Medicare Advantage in Rhode Island

Most Rhode Island residents qualify for Medicare when they turn 65, but it’s also available to younger adults with certain disabilities. Medicare enrollment is limited to U.S. citizens and lawfully admitted immigrants. To enroll in Medicare Advantage, an applicant must also be eligible for both parts of Original Medicare and live within their selected plan’s service area.

Medicare has specific enrollment periods each year, so it’s important for applicants to time their enrollment carefully. The list below provides details about enrolling in Medicare Advantage for the first time, choosing a different Medicare Advantage Plan or switching from Medicare Advantage to Original Medicare.

• Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
• Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
• Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.

Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.

How to Find & Choose a Medicare Advantage Plan in Rhode Island

Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.

First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.

State-Wide Medicare Advantage Resources

Local Medicare Advantage Resources